Paul J. Hershberger

Stress, Negative Social Exchange, and Health Symptoms in University Students

Abstract Although social support has been studied extensively in terms of its role in the relationship between stress and health, less attention has been devoted to the impact of negative social interactions. In this investigation, the authors examined the unique contributions of positive social support and negative social exchange in the relationship between stress and health symptoms, using data from 206 undergraduates at a large state university. Negative social exchange accounted for more variance in physical health symptoms than did life-event stress, daily hassles, or social support. The relationship between negative social interaction and physical symptoms was not the result of variance shared with psychological well-being. The importance of attending to negative aspects of social interaction among university students in terms of their health and well-being is discussed.

Personality and appointment--keeping adherence in cardiac rehabilitation.

PURPOSE Literature reviews typically have concluded that personality factors are unrelated to adherence to treatment programs, including adherence to exercise prescribed in cardiac rehabilitation. This study constitutes a reconsideration of this conclusion. Using the California Psychological Inventory (CPI), a well-validated inventory of general personality tendencies, personality variables, and appointment-keeping in cardiac rehabilitation were examined. METHODS Forty-nine men entering a cardiac rehabilitation program completed the CPI. Exercise capacity was measured on entry into the 4-month phase II/III program and at completion. Adherence indicators were appointment-keeping and completion or non-completion of the program. General appointment-keeping and hospital admissions during the subsequent year were tracked. RESULTS Appointment-keeping accounted for 35% of the variance in posttreatment exercise capacity, controlling for pretreatment exercise capacity. Scores on the CPI scales that were significantly related to appointment-keeping were Well-Being (perception of physical/emotional health), Socialization (acceptance of rules and regulations), and Communality (view of self as similar to others). These correlations ranged from 0.49 to 0.38. Those who completed the program (n = 39) had higher scores than those who did not (n = 10) on nearly all of the CPI scales. The differences were significant on the Socialization and Good Impression scales (desire for others to have a favorable impression of oneself). The Socialization score was correlated with keeping appointments in the follow-up year. CONCLUSION Personality variables were associated with appointment-keeping adherence. The consistency of our results with those of other recent studies of personality and adherence is discussed, along with implications for cardiac rehabilitation.

Who Determines Physician Effectiveness

It is a paradox. Although physicians do not control patient behavior, physician effectiveness is increasingly determined by patient behavior. There is a trend toward physician ratings being based on specific metrics related to the management of chronic illness. Such markers include glycosylated hemoglobin levels, blood pressure, body mass index, and smoking rates, along with other factors known to affect risk of morbidity and mortality. However, the physician contribution to changing the actual outcomes is limited. Population analyses of health outcomes suggest that medical care accounts for only 10% of the variance in outcomes, whereas approximately 50% can be attributed to behavioral and social factors.1 With respect to the chronic conditions that receive the largest proportion of health care attention, such as cardiovascular disease and diabetes, physicians identify risk factors,

A longitudinal study of attitudes toward physician-assisted suicide and euthanasia among patients with noncurable malignancy.

This longitudinal study investigated whether attitudes toward physician-assisted suicide (PAS) and euthanasia (E) are stable among patients with noncurable malignancy, and whether depression and various coping strategies were related to such attitudes. Thirty patients with noncurable malignancies completed questionnaires measuring attitudes toward PAS and E, depression, and coping. Three months later, and subsequently at six-month intervals, repeated measures were obtained from 24 patients. There was a trend for patients to become less supportive of legalizing PAS and E from the initial to last attitude measurement. Depression was unrelated to attitude change. There were significant changes on two coping dimensions: use of social support for emotional reasons and use of religious resources. Our findings should be considered in clinical, legislative, and ethical debates.

Coping with Job Transitions over the Work Life

A job transition is a process involving a number of steps, including thinking about goals and skills, evaluating the potential job market, conducting the job search, managing personal reactions, and negotiating entry into the new organization. As both a common and impactful transition of modern life, it is important to examine the factors associated with coping with job transitions. Specifically, we would like to consider the societal changes in the current work context, and the research evidence indicating job transitions can be significant life stressors. We then examine the role that coping plays in the transition process, and outline our mediation model of antecedents, coping and outcomes. Case studies of job transitions at four points in the work-life are presented to illustrate the model. We search for common themes and issues in the process of job transitions across the work-life, and raise questions regarding how these may be uniquely played out at different points in an individual’s life. The implications for the professional’s role in helping individuals and organizations facilitate transitions are discussed. Finally, we present directions for future research.

Implementation of a Process-Oriented Cultural Proficiency Curriculum

The authors implemented a process-oriented cultural proficiency curriculum in their family medicine residency program, emphasizing the understanding of each individual patient through skilled interviewing rather than promoting the acquisition of knowledge about specific cultural groups.

Explanatory style and the performance of residents

Explanatory (i.e. attributional) style has been shown to be related to performance, especially when attributions are pessimistic. This study tested whether this relationship was present for residents.

Professionalism: self-control matters.

Background: Many of the behaviors that constitute professionalism require self-control. Aim: To investigate the extent to which self-control is a component of resident professionalism, rated both by residents and their program directors. Methods: 366 residents in 13 residency programs were invited to participate in a survey study of professionalism. Participating residents completed the Professionalism – Documentation of Competence (ProDOC) (a 15-item measure of professionalism developed for the study), a 10-item version of the Marlowe–Crowne Social Desirability Scale, and the Brief Self-Control Scale. Independently, program directors of participating residents completed the ProDOC with reference to each of their participating residents. Results: 215 residents agreed to participate in the study (58.7% response rate). Resident ProDOC scores were significantly related to social desirability and self-control. Self-control alone accounted for approximately 25% of the variance in resident ProDOC scores, and approximately 17% of the variance in ProDOC scores when shared variance with social desirability was controlled. There was no correlation between resident and program director ProDOC scores. Conclusions: Self-control is an important facet of human behavior and interpersonal interaction, including the behaviors that constitute medical professionalism. The lack of correlation between residents’ self-ratings of professionalism and their program directors’ ratings underscores the difficulty in understanding and measuring this competency.

Nonevents and adult well-being

Abstract Both the nonoccurrence of positive expected life events (nonevents) and their role in adulthood have received little research attention, even though nonevents have potential to impact lives profoundly. To obtain data on the experience of nonevents and their perceived impact, we developed the Life Experiences Assessment Form (LEAF). In three exploratory studies, 62%–95% of participants reported the experience of one or more nonevents. Using different measures of well-being in the three studies, there was a trend in which persons reporting more nonevents had lower indices of well-being. A stronger relationship was present between perceiving nonevents as having a negative impact and lower well-being scores. These relationships persisted when negative affectivity was controlled. Overall, nonevents were perceived as having less personal impact than events that had occurred. Nonevents appear to be related to adult well-being.